First session
Time:9.00am
Location: Kubang Pasu District Health Office
Topic: primary health care
Person in charge: PPPK Mohd. Amin b. Saad
The fine morning started off with a briefing about the various divisions and functions of the primary health care, activities for the geriatrics age group which included morning workouts and establishments of various clubs which played an active role in geriatrics health. The function of the Primary Health care are:
• Outpatient department
• Maternal and child clinic
• Special programmes ( geriatrics care)
• Rehabilitation
• Library
This is followed by an excursion to the klinik kesihatan Tunjang at around 10.30 a.m. There we were briefed about the green book which is used to record information and track the health record of diabetic patients. This book allows the proper documentation of the health progress of diabetic patients. There are two copies of the green book which are exactly the same in contents, where the larger one is kept as a record by the clinic and the smaller version kept by the patients themselves.
The other book was the blue book for recording information of hypertensive patients
Thursday, July 30, 2009
Kubang Pasu District
Time: 2pm
Venue: Meeting room
Activity: Health promotion En Amir Faruq
Around 230pm Dr Sapna and her team came to visit us and ask us about the progress in our DHO posting. They asked what we have done the past few days and asked us different questions that we later found out from the respective units.
Later, after the meeting, we had a talk on Health Promotion which was given by Encik Amir Faruq. He told us the functions and objectives of health promotion. There are only 3 persons handling the unit. This unit is operational all year round and they have certain targets to be accomplished by the end of the year.
He also explained to us about ‘Program Doktor Muda’ and PROSTAR.
-‘Program Doktor Muda’: This program is for the primary school students (standard 4-6). However, only the selected few which are the grade A students, are chosen for this program. This program was introduced in 1998 and fully functionally in year 2000. This program is conducted up to the national level. The main objective of this program is to expose the young minds to general health.
-‘PROSTAR’: This program is for secondary school students, where the main objective is to nurture and cultivate good morale among the teenagers.
The main objective of PROSTAR is ,To increase awareness and knowledge of the dangers of HIV infection, prevention and control measures, To instill a positive attitude amongst teenagers about the problems of HIV which is also connected to teenage social issues, To encourage teenagers to practice healthy lifestyle and to stay away from high risk behaviors’ that may put them at risk for HIV infection, To form a group of Pembimbing Rakan Sebaya (PRS) who can influence teenagers towards healthy living and also to encourage them to fight AIDS, and finally To create a group of PRS who would take the role as social service volunteers to give support service to other teenagers.
Although others such as NCD and CDC department also doing health promotion, this department will give the ideas and encourage some activities that are suitable during their health promotion. They will help each other’s among their department
Among the other activities that they do are under health promotion are:
-Exhibition
-Health Campaign
-Carnival; which is usually conducted for 3 days.
-Talks
Kubang Pasu District
First session
Date: 12th July 2009
Time: 9.00am
Location: Kubang Pasu District Health Office, Jitra
Topic: Tagging System,Immunisation,Pap Smear, Maternal & Child Health, Geriatrics (Family Health and Development Department)
Person in charge: Sister Zurida bt Abd Hamid
We assembled in the DHO meeting room to attend a talk by Sister Zurida bt Abd Hamid. There are 8 klinik kesihatan (Klinik Ibu &Anak) and 21 Klinik Desa in Kubang Pasu district. This unit provides services such as antenatal care, postnatal care, child care (for child age between 0-6 years old), School Health, Geriatrics care, Public Health, Prostar, Mental Health, Food and Diabetic care, Home Care Nursing (for geriatrics and chronic case only), Rehabilitation clinic, and also Dental care. We were briefly explained about the operation policy of Klinik Kesihatan (which includes all types of clinic available) in Kubang Pasu according to BUKU B.
The objective of Klinik Kesihatan is to provide comprehensive and quality service to the community to enhance the status of public health and to improve the accessibility to the health services. The organization chart of Kubang Pasu DHO and the function of various departments under this unit such as pharmacy, laboratory, clinical, imaging and administrative function was explained.
Klinik kesihatan provides its services:
• to walk-in patients,
• patient referred from various types of health care center
• they handles minor surgeries
• Non CD cases such as diabetes, high BP, Asthmatic, psychiatric patient, heart patient, and occupation related diseases.
• Ambulatory Medical Emergency treatment
• Simple fractures, minor orthopedic cases
• Besides that, this unit also responsible to prepare medical report, reten HMIS and carry out health promotion to their patient who visits their clinic.
• Screening test
• Last but not least, the aim in this clinic in this district is to give importance to antenatal care, including from beginning until the end of this period (more focus in this area).
Date: 12th July 2009
Time: 9.00am
Location: Kubang Pasu District Health Office, Jitra
Topic: Tagging System,Immunisation,Pap Smear, Maternal & Child Health, Geriatrics (Family Health and Development Department)
Person in charge: Sister Zurida bt Abd Hamid
We assembled in the DHO meeting room to attend a talk by Sister Zurida bt Abd Hamid. There are 8 klinik kesihatan (Klinik Ibu &Anak) and 21 Klinik Desa in Kubang Pasu district. This unit provides services such as antenatal care, postnatal care, child care (for child age between 0-6 years old), School Health, Geriatrics care, Public Health, Prostar, Mental Health, Food and Diabetic care, Home Care Nursing (for geriatrics and chronic case only), Rehabilitation clinic, and also Dental care. We were briefly explained about the operation policy of Klinik Kesihatan (which includes all types of clinic available) in Kubang Pasu according to BUKU B.
The objective of Klinik Kesihatan is to provide comprehensive and quality service to the community to enhance the status of public health and to improve the accessibility to the health services. The organization chart of Kubang Pasu DHO and the function of various departments under this unit such as pharmacy, laboratory, clinical, imaging and administrative function was explained.
Klinik kesihatan provides its services:
• to walk-in patients,
• patient referred from various types of health care center
• they handles minor surgeries
• Non CD cases such as diabetes, high BP, Asthmatic, psychiatric patient, heart patient, and occupation related diseases.
• Ambulatory Medical Emergency treatment
• Simple fractures, minor orthopedic cases
• Besides that, this unit also responsible to prepare medical report, reten HMIS and carry out health promotion to their patient who visits their clinic.
• Screening test
• Last but not least, the aim in this clinic in this district is to give importance to antenatal care, including from beginning until the end of this period (more focus in this area).
Kubang Pasu District
Second session (Evening Session)
Date: 12th July 2009
Time 2:00pm
Location: School Unit, District Health Office Kubang Pasu, Jitra
Topic: Excursion to KKIA Jitra, School Unit, briefing on School Health Programme
Person in charge: JK Zulfadzilah bt. Ahmad
In the afternoon, we were briefed on the function of School health unit which is responsible on vaccination of the school children, personal hygiene, food and nutrition monitoring, Programme Doktor Muda and PROSTAR. There are 55 primary school, 25 secondary and 44 preschools in Kubang Pasu district. A School Team is comprised of 2 nurses, 1 attendant, 1 driver and MA (STUDENT)
Standard 1 students:
· OPV, MMR & DT is given
· Talk on personal hygiene, methods of brushing teeth and visual assessment.
Standard 6 students:
- Rubella is given to female students ( will be stoped in year 2010)
- Boys are checked for colour blind.
Form 3 students:
- ATT is given and physical examination is carried out
Wednesday, July 22, 2009
KMAM -PADANG TERAP
KMAM
Unit Kawalan Mutu Air Minum (KMAM) is headed by Mr. Saiful. The objective of KMAM is to monitor the quality of drinking water. There are five treatment plants in Padang Terap. They are situated in Kuala Nerang, Padang Senai, Lubuk Merbau, and Nami.
The water quality monitoring activity is a four network system and involves all five water treatment plants. They are:
Network 1 = Kuala Nerang A and B
Kuala Nerang Water Treatment Plant
Network 2 = Lubuk Merbau Water Treatment Plant
Network 3 = Nami Water Treatment Plant
Network 4 = Padang Sanai Water Treatment Plant
Water is sampled from 27 sampling stations. 4 from Intake, 5 from Treatment Plant Outlets, 5 from Service Reservoir Outlet, and 13 from the distribution centre.
The water sampled is analyzed under 3 different components. They are physical, chemical and microbiological. Under the physical component, water is tested for the turbidity, colour, pH and temperature.
Chemical analysis is further subdivided into short and long analysis. The short analysis involves test such as fluoride and chloride level while the long analysis involves testing for heavy metals such as argentum and zinc.
Microbiologically, the water sample is tested for E. coli and fecal coliform. Ideally these organisms should not be present.
Procedure for Water Sampling
1. The tap is fully opened and water is let to run for 2-5 minutes.
2. Then the tap is shut.
3. After that the pipe is heated up by direct flame for 3 minutes to remove any contamination.
4. The water is then collected.
Procedure for Water Treatment in Kuala Nerang Treatment Plant
1. The raw water undergoes a process of aeration. The purpose of aeration is to oxidize the water, thus increasing content of oxygen.
2. Next, it undergoes a process of flocculation in which Polyaluminium Chloride (PAC) is added to the water. PAC is a coagulant and it will form floc.
3. After that, the water will be directed to the sedimentation tank. Here, the floc sinks down the tank leaving cleaner water on top. This tank is washed fortnightly.
4. The fourth step involves filtration of the water. Here, the filter used is the rapid sand filter. It consists of two layers which are of rough sand and fine sand. There are 6 filters in total in this plant.
a. Cleaning of the filter is done every 3 days. First water is drained then the blower is used to get rid of mud balls.
5. The water is then directed to the contact tank, where fluorine and chlorine is added to it. Water is left there for 4 hours so that the chemicals dissolve evenly.
6. Then water enters into the clear water tank where lime is added to raise the pH of the water. The ideal pH is from 6.5-9.0.
7. This treated water is then pumped to the Service Reservoir Outlet for distribution.
Unit Kawalan Mutu Air Minum (KMAM) is headed by Mr. Saiful. The objective of KMAM is to monitor the quality of drinking water. There are five treatment plants in Padang Terap. They are situated in Kuala Nerang, Padang Senai, Lubuk Merbau, and Nami.
The water quality monitoring activity is a four network system and involves all five water treatment plants. They are:
Network 1 = Kuala Nerang A and B
Kuala Nerang Water Treatment Plant
Network 2 = Lubuk Merbau Water Treatment Plant
Network 3 = Nami Water Treatment Plant
Network 4 = Padang Sanai Water Treatment Plant
Water is sampled from 27 sampling stations. 4 from Intake, 5 from Treatment Plant Outlets, 5 from Service Reservoir Outlet, and 13 from the distribution centre.
The water sampled is analyzed under 3 different components. They are physical, chemical and microbiological. Under the physical component, water is tested for the turbidity, colour, pH and temperature.
Chemical analysis is further subdivided into short and long analysis. The short analysis involves test such as fluoride and chloride level while the long analysis involves testing for heavy metals such as argentum and zinc.
Microbiologically, the water sample is tested for E. coli and fecal coliform. Ideally these organisms should not be present.
Procedure for Water Sampling
1. The tap is fully opened and water is let to run for 2-5 minutes.
2. Then the tap is shut.
3. After that the pipe is heated up by direct flame for 3 minutes to remove any contamination.
4. The water is then collected.
Procedure for Water Treatment in Kuala Nerang Treatment Plant
1. The raw water undergoes a process of aeration. The purpose of aeration is to oxidize the water, thus increasing content of oxygen.
2. Next, it undergoes a process of flocculation in which Polyaluminium Chloride (PAC) is added to the water. PAC is a coagulant and it will form floc.
3. After that, the water will be directed to the sedimentation tank. Here, the floc sinks down the tank leaving cleaner water on top. This tank is washed fortnightly.
4. The fourth step involves filtration of the water. Here, the filter used is the rapid sand filter. It consists of two layers which are of rough sand and fine sand. There are 6 filters in total in this plant.
a. Cleaning of the filter is done every 3 days. First water is drained then the blower is used to get rid of mud balls.
5. The water is then directed to the contact tank, where fluorine and chlorine is added to it. Water is left there for 4 hours so that the chemicals dissolve evenly.
6. Then water enters into the clear water tank where lime is added to raise the pH of the water. The ideal pH is from 6.5-9.0.
7. This treated water is then pumped to the Service Reservoir Outlet for distribution.
Kesihatan Pekerjaan dan Alam Sekitar (KPAS)-PADANG TERAP
Kesihatan Pekerjaan dan Alam Sekitar (KPAS)
Vision
Towards creating a safe and healthy working environment for the staffs of Ministry of Health (MOH) in Padang Terap as well as for the customers through health promotion.
Mission
To create a conducive working environment by identifying hazards and taking actions to manage them, and to promote a quality level of health through prevention and control of disease, injury, and disability between men and work.
Objectives
General
To raise and maintain the physical, social and mental well being of every staff of MOH in the district of Padang Terap at the optimum level.
Specific
1) To maintain a healthy and safe working environment, working process and daily practices as well as to prevent any health problem arising which may occur due to the occupation or environment.
2) To increase the level of knowledge and awareness about occupational health and safety among employers, employees and customers.
3) To increase the level of health, safety and well-being of individuals through prevention and disease control activities in a workplace.
4) To increase quality and productivity through increasing the level of health, safety and well-being of individual
Methodology
1) By integrating primary health care and occupational health programme.
2) Provide training to the staffs in relation to occupational health.
3) To strengthen the surveillance network of the epidemiology of occupational diseases including chemical and pesticide poisoning.
4) To promote occupational health and safety.
5) To strengthen the cooperation and coordination of activities among various sectors, departments or agencies.
Activities
1) Notification and surveillance of occupational diseases.
2) “Quality Assurance” indicators, for example incidence rate of needlestick injuries.
3) Establishment of occupational health and safety committee.
4) Health and safety promotion at workplace by:
- Talks, courses and training.
- Providing necessary material for health education.
- Conducting ‘Workplace Risk Assessment.
5) Investigate complaints regarding occupational health and safety.
6) Conduct training/workshops/courses for staffs regarding occupational health and safety.
7) Conduct occupational health and safety assessment for health facilities.
8) Monitor health checks among healthcare workers
9) Monitor and conduct ‘Healthy Setting’ activities.
10) Conduct household safety assessment.
11) Conduct playground safety assessment.
12) PLKN assessment from time to time.
13) Assessment of building plan by local authority.
14) Assessment of license application for entertainment outlet.
15) Conduct sanitary assessment of schools/institutes
Vision
Towards creating a safe and healthy working environment for the staffs of Ministry of Health (MOH) in Padang Terap as well as for the customers through health promotion.
Mission
To create a conducive working environment by identifying hazards and taking actions to manage them, and to promote a quality level of health through prevention and control of disease, injury, and disability between men and work.
Objectives
General
To raise and maintain the physical, social and mental well being of every staff of MOH in the district of Padang Terap at the optimum level.
Specific
1) To maintain a healthy and safe working environment, working process and daily practices as well as to prevent any health problem arising which may occur due to the occupation or environment.
2) To increase the level of knowledge and awareness about occupational health and safety among employers, employees and customers.
3) To increase the level of health, safety and well-being of individuals through prevention and disease control activities in a workplace.
4) To increase quality and productivity through increasing the level of health, safety and well-being of individual
Methodology
1) By integrating primary health care and occupational health programme.
2) Provide training to the staffs in relation to occupational health.
3) To strengthen the surveillance network of the epidemiology of occupational diseases including chemical and pesticide poisoning.
4) To promote occupational health and safety.
5) To strengthen the cooperation and coordination of activities among various sectors, departments or agencies.
Activities
1) Notification and surveillance of occupational diseases.
2) “Quality Assurance” indicators, for example incidence rate of needlestick injuries.
3) Establishment of occupational health and safety committee.
4) Health and safety promotion at workplace by:
- Talks, courses and training.
- Providing necessary material for health education.
- Conducting ‘Workplace Risk Assessment.
5) Investigate complaints regarding occupational health and safety.
6) Conduct training/workshops/courses for staffs regarding occupational health and safety.
7) Conduct occupational health and safety assessment for health facilities.
8) Monitor health checks among healthcare workers
9) Monitor and conduct ‘Healthy Setting’ activities.
10) Conduct household safety assessment.
11) Conduct playground safety assessment.
12) PLKN assessment from time to time.
13) Assessment of building plan by local authority.
14) Assessment of license application for entertainment outlet.
15) Conduct sanitary assessment of schools/institutes
BAKAS – Bekalan Air dan Kebersihan Alam Sekeliling.-PADANG TERAP
BAKAS – Bekalan Air dan Kebersihan Alam Sekeliling.
Objectives:
To increase the standard of health and cleanliness of the villagers and reduce the incidence of communicable diseases through encouraging a clean environment, clean and safe water supply and usage of a complete sanitary toilet.
Activities:
Provide complete flushing toilets, either by modification or supplying new ones.
Supply polypipe and fittings to enable a connection to JKR or KKM water supplies.
Building of “control wells”
Building of “control wells” with connections to houses
Building of Gravitational Feed System (GFS)
Building of rain water collection system (STAH – sistem tadahan air hujan)
Building of proper drainage system for used water (SPAL – Sistem pelupusan air limbah)
Building of solid waste disposal system ( SPSP – Sistem pelupasan sisa pepejal)
Surveillance and sampling of suburban water supply.
Health education, advice and monitoring environmental cleanliness.
Control and prevention of complications of iodine deficiency.
Tourist attractionsanitary examination program.
The wells built are all of no cost to the occupants of the villages.
There are two types of wells, one a manual pump, the other powered by electrical motor. The system is free of charge, but the villagers have to pay for the electrical bill. The electrical system is normally built in preference to the manual system, except in cases where no electricity is available.
Each well undergoes evaluation twice a year.
There is only one well drilling machine in the entire state of Kedah. (And it’s 30 years old)
There are a total of 32 wells currently servicing the district of Padang Terap.
Previously the toilets were built for the villagers by the unit, but since the increase in demand, they now build one as a model and ask the villagers to reproduce for themselves.
There are 2 GFS in Padang Terap; Perik and Puncak Janing.
Water from a river is collected into a man made reservoir where it builds up enough potential energy to provide a continuous water supply through a filter into thick PVC pipes which carries the water to the villagers.
SPAL works in the following way;
Water from the sink enters a filter box which separates it from most of the food waste.
The filter is cleaned every 3 to 4 days.
The water then enters an underground water collection tank.
When that is full, it pours out the water through freely laid out gravel which acts like a filter before passing into a second collection tank.
From there it is then carried away through the general drainage system.
We’d like to thank the villagers for giving us some of the best rambutans we’ve had and also for showing us a smoking monkey.
Objectives:
To increase the standard of health and cleanliness of the villagers and reduce the incidence of communicable diseases through encouraging a clean environment, clean and safe water supply and usage of a complete sanitary toilet.
Activities:
Provide complete flushing toilets, either by modification or supplying new ones.
Supply polypipe and fittings to enable a connection to JKR or KKM water supplies.
Building of “control wells”
Building of “control wells” with connections to houses
Building of Gravitational Feed System (GFS)
Building of rain water collection system (STAH – sistem tadahan air hujan)
Building of proper drainage system for used water (SPAL – Sistem pelupusan air limbah)
Building of solid waste disposal system ( SPSP – Sistem pelupasan sisa pepejal)
Surveillance and sampling of suburban water supply.
Health education, advice and monitoring environmental cleanliness.
Control and prevention of complications of iodine deficiency.
Tourist attractionsanitary examination program.
The wells built are all of no cost to the occupants of the villages.
There are two types of wells, one a manual pump, the other powered by electrical motor. The system is free of charge, but the villagers have to pay for the electrical bill. The electrical system is normally built in preference to the manual system, except in cases where no electricity is available.
Each well undergoes evaluation twice a year.
There is only one well drilling machine in the entire state of Kedah. (And it’s 30 years old)
There are a total of 32 wells currently servicing the district of Padang Terap.
Previously the toilets were built for the villagers by the unit, but since the increase in demand, they now build one as a model and ask the villagers to reproduce for themselves.
There are 2 GFS in Padang Terap; Perik and Puncak Janing.
Water from a river is collected into a man made reservoir where it builds up enough potential energy to provide a continuous water supply through a filter into thick PVC pipes which carries the water to the villagers.
SPAL works in the following way;
Water from the sink enters a filter box which separates it from most of the food waste.
The filter is cleaned every 3 to 4 days.
The water then enters an underground water collection tank.
When that is full, it pours out the water through freely laid out gravel which acts like a filter before passing into a second collection tank.
From there it is then carried away through the general drainage system.
We’d like to thank the villagers for giving us some of the best rambutans we’ve had and also for showing us a smoking monkey.
Tuesday, July 21, 2009
INFORMATION ABOUT FOMEMA
FOMEMA -Foreign Workers Medical Examination Monitoring Agency FOMEMA strives and aims to ensure that identified communicable diseases are prevented from entering the country through our stringent monitoring and supervision of medical examinations on foreign workers. | |||||||||||||||||||||||||||
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Adolescent Health - Sik district
Adolescent Health
Vision
- adolescent will enjoy peaceful and quality life with knowledge and skills for healthy behavior
Mission
- prepare whole and optima health services and enough support for adolescent, through increase in awareness, knowledge, skills and cooperation between agencies and societies and active involvement of adolescent in planning and implementation of health services.
Objective
- planning and preparing health services for all the adolescent include physical, mental, social and spiritual for healthy behaviors direction.
Specific objective
- support the spirit of formation of adolescent group with encouragement of healthy and responsible lifestyle.
- Prevent the social problems due to risky behaviors by promoting the healthy lifestyle and preparing appropriate care for health
- Encourage active participation of adolescent in activities with health promotion and prevention.
Definition
Adolescent can be categorized into
: early adolescent stage – 10 to 14 year old
: middle adolescent stage – 15 to 17 year old
: late adolescent stage – 18 to 19 year old
Adolescent health services:
- promotion and education about adolescent health
- screening for adolescent health
- treatment for adolescent
- Counseling
- Reference services
Other optional services :
- activities
- counseling for adolescent diet
- focus group counseling or family counseling
- promotion of adolescent health like exhibition, seminar, camp, etc
- adolescent club, health club, PROSTAR, etc
Services provided by the health clinics:
- Growth and development
- Diet
- Mental
- Sexual and reproductive
- Risky behaviour
- Physical
SKR form (Borang Saringan Kesihatan Remaja)
SKR-1 for male
SKR-2 for female
This form is used to identify the adolescent problems which related to diet, growth, mental, sexual and reproductive, accident risk, smoking, alcohol and drug usage among adolescent.
This screening is done at least 3 times according to the categories mentioned above due to each stage there will be different emotional and behavior problems which tend to change with time.
- Opportunistic screening in health clinics
- Periodically screening in school
Flow chart of the process of main job in adolescent health services
Vision
- adolescent will enjoy peaceful and quality life with knowledge and skills for healthy behavior
Mission
- prepare whole and optima health services and enough support for adolescent, through increase in awareness, knowledge, skills and cooperation between agencies and societies and active involvement of adolescent in planning and implementation of health services.
Objective
- planning and preparing health services for all the adolescent include physical, mental, social and spiritual for healthy behaviors direction.
Specific objective
- support the spirit of formation of adolescent group with encouragement of healthy and responsible lifestyle.
- Prevent the social problems due to risky behaviors by promoting the healthy lifestyle and preparing appropriate care for health
- Encourage active participation of adolescent in activities with health promotion and prevention.
Definition
Adolescent can be categorized into
: early adolescent stage – 10 to 14 year old
: middle adolescent stage – 15 to 17 year old
: late adolescent stage – 18 to 19 year old
Adolescent health services:
- promotion and education about adolescent health
- screening for adolescent health
- treatment for adolescent
- Counseling
- Reference services
Other optional services :
- activities
- counseling for adolescent diet
- focus group counseling or family counseling
- promotion of adolescent health like exhibition, seminar, camp, etc
- adolescent club, health club, PROSTAR, etc
Services provided by the health clinics:
- Growth and development
- Diet
- Mental
- Sexual and reproductive
- Risky behaviour
- Physical
SKR form (Borang Saringan Kesihatan Remaja)
SKR-1 for male
SKR-2 for female
This form is used to identify the adolescent problems which related to diet, growth, mental, sexual and reproductive, accident risk, smoking, alcohol and drug usage among adolescent.
This screening is done at least 3 times according to the categories mentioned above due to each stage there will be different emotional and behavior problems which tend to change with time.
- Opportunistic screening in health clinics
- Periodically screening in school
Flow chart of the process of main job in adolescent health services
Child Health - Sik district
Child Health
There are various aspects of child health:
- Nutrition
- Growth & Development
- Immunization
- Maternal and Child Health Clinic
- School Health
Millennium Development Goals (for child health)
- Goal 4: Reduce child mortality
- Target 5: Reduce by two-thirds, between 1990 and 2015, the under-five mortality rate
Under-five mortality rate
Infant (under 1) mortality rate
Proportion of 1-year-old children immunised against measles
The National Breastfeeding Policy (2006) states:
“All mothers are encouraged to breastfeed their babies exclusively with breast milk from birth until 6 months of age and thereafter to continue until the child is 2 years old. Complementary foods should be introduced when the baby is 6 months old.”
World Breastfeeding Week 2009 is 1-7 August 2009
Baby Friendly Hospital Initiative
Ten steps to successful breastfeeding [A joint WHO/UNICEF statement (1989)]
Every facility providing maternity services and care for newborn infants should :
1. Have a written breastfeeding policy that is routinely communicated to all health care staff.
2. Train all health care staff in skills necessary to implement this policy.
3. Inform all pregnant women about the benefits and management of breastfeeding.
4. Help mothers initiate breastfeeding within half-hour of birth
5. Show mothers how to breastfeed, and how to maintain lactation even if they should be separated from their infants.
6. Give newborn infants no food or drink other than breast milk unless medically indicated.
7. Practise rooming-in allows mothers and infants to remain together-24 hours a day.
8. Encourage breastfeeding on demand.
9. Give no artificial teats or pacifiers (also called dummies or soothers) to breastfeeding infants.
10. Foster the establishment of breastfeeding support group and refer to them on discharge.
Breastfeeding and Child Survival
1. Follow the breastfeeding policy
- exclusive breastfeeding from birth to first 4-6 months
- no pacifier
- additional food only be given after the baby 4-6 months old
2. Advantages of breast milk compare to formulated milk
- prevent infection(bacteria, virus), respiratory infection and diarrhea
- prevent the baby from allergic
- sudden infant rate decreases
3. Colostrums
- high proteins, fat soluble vitamins (Vit A, D, E, K), zinc and sodium
- Low lactose(4%), fats and water soluble vitamins (Vit B complex, C)
- High vitamin K (prevent Haemorrhagic Disease of Newborn)
- High sIgA
- Passive immunization
- Stimulate passing out of meconium – to prevent neonatal jaundice
- Contain “Bifidus factors” which encourage the growth of Lactobacillus Bifidus – to prevent the growth of pathogenic E.coli.
- Active enzymes like lipase, lactase, lysozyme
- Antioxidant, Beta kerotene
4. Advantages for the mother
- oxytocin produced during breastfeeding will help the involution of uterus and prevent postpartum hemorrhage.
- Natural contraception
- Decrease the risk of breast cancer
- Decreases post partum psychosis
To overcome nutritional diseases and deficiencies, especially prevalent in rural areas, the Government initiated the multi-agency “Applied Food and Nutrition” programme in the 1970s and the “School Supplementary Feeding Programme” to provide children from low income families with food supplements including milk.
As a result, acute malnutrition is no longer a problem in our country.
Trends between 1990 and 2001 in under-five weight for age show that not more than 1% are severely underweight. On the other hand, Malaysia has begun to see the emergence of overweight and obesity in both children and adults.
School Supplementary Feeding Program (SSFP)[Rancangan Makanan Tambahan(RMT)]
- The main objective of SSFP is to improve the health and nutritional status of children, especially those from the rural areas, through a provision of a wholesome and balanced meal.
- To improve health and food habits and to prevent the occurrence of malnutrition among school children
- To educate children on food selection
- To encourage the participation of parents, teachers and public in the welfare of the school
- To strengthen health and nutrition programs in schools
Other informations will be posted soon. .. .
Family planning in Sik
Family planning.
Date: 7/7/09
By: Ketua Jururawat Masyarakat- Nur Aziah Ismail
Blogged by: Mark Paul
Aim of family planning is to space out pregnancies.
Benefits to mother: prevent maternal depletion syndrome, provide sufficient time for mother’s body to replenish stores; able to provide sufficient attention and care to each child.some mothers have heart disease or autoimmune diseases such as SLE, which require longer spacing as pregnancy worsens the disease and can lead to maternal death.
Will not be a burden to mothers if pregnancies are spaced out.
Benefit to child: able to get sufficient attention and care from mother. Prevents IUGR and small for gestational age (SGA).
Main age group of users in Sik: women/mothers of 20-35 years old.
How: staff nurses and the community nurses ( jururawat masyarakat) give the mothers counseling about family planning and contraception during antenatal period and also postnatal period.The counseling is given to the mothers and their husbands.They even hold small talks to the couples, to educate them about family planning. It is done from time to time. The ultimate choice of to use contraception or types of contraception used lies on the couple’s decision.
Methods: male condoms- are commonly used method. Couple comes to KKIA twice a month, each visit they get 12 condoms, that is 24 condoms per month.
oral contraceptive pills- combined and progesterone only pills- COCP, POP. In terms on medication, COCP is the most common among pills, depo-provera IM injectios and Multiload copper IUCD.
COCP used in Sik are Regivedon, Marvelon. Starts 42 days after delivery or when menstrual cycle starts. Not used if candidate have risk factors or history of heart disease, thromboembolism, breast and ovarian cancer.
POP used is Noriday- commonly used if mother is still breastfeeding. Starts by 0-6 months after delivery; COCP causes non-lactation..
Both COCP & POP are available in all KK and KD is Sik. Can be started by staff nurses, community nurses, MOs, FMS. Before starting them on pills, an extensive history is taken regarding the heart diseases, breast problems, thromboembolism.
Depo provera injections via IM lasts for 3 months, also available in all KK & KD in Sik. Can be administered by staff nurses, community nurses, MOs, FMS.
IUCD is only available in KK Jeniang (because FMS is stationed there) and KKIA Sik (by MO or FMS only). Can’t be administered by nurses.
The IUCD used here is Multiload copper IUCD, its market value is rm 250. Mirena is RM500, therefore it is not used. Suitable for women who tend to forget.
IUCD lasts for 3 years. It is inserted 42 days after delivery or 5 days after mensus begin. First, US scan is done to measure the cervix length, based on that measurement, the applicator length is adjusted too. Upon insertion, US scan is done again to determine if it is correctly placed. A review is done 6 weeks later using US scan. After that, annual review is done. It is only removed when 3 years period expired or when mother plan to get pregnant.
All methods are provided free by KK & KKIA & KD.
For women who is having heart disease, renal failure, SLE and others, which pregnancy worsens the disorders, they will require Norplant or Implanon, lasts for 5 years, to be done in LPPKN clinic in Sungai Petani and Baling. The couple bear the costs.
JM Suraya says family planning is very well accepted by the people of Sik and she says it is working well.
The financial allocation is provided by finance unit of PKD, the Sister buys the stocks from either the supplier, or via government tender. From KKIA Sik, she distribute them to the other KK and KD.
Unfortunately, there is no NGO operating in this field in Sik.
Date: 7/7/09
By: Ketua Jururawat Masyarakat- Nur Aziah Ismail
Blogged by: Mark Paul
Aim of family planning is to space out pregnancies.
Benefits to mother: prevent maternal depletion syndrome, provide sufficient time for mother’s body to replenish stores; able to provide sufficient attention and care to each child.some mothers have heart disease or autoimmune diseases such as SLE, which require longer spacing as pregnancy worsens the disease and can lead to maternal death.
Will not be a burden to mothers if pregnancies are spaced out.
Benefit to child: able to get sufficient attention and care from mother. Prevents IUGR and small for gestational age (SGA).
Main age group of users in Sik: women/mothers of 20-35 years old.
How: staff nurses and the community nurses ( jururawat masyarakat) give the mothers counseling about family planning and contraception during antenatal period and also postnatal period.The counseling is given to the mothers and their husbands.They even hold small talks to the couples, to educate them about family planning. It is done from time to time. The ultimate choice of to use contraception or types of contraception used lies on the couple’s decision.
Methods: male condoms- are commonly used method. Couple comes to KKIA twice a month, each visit they get 12 condoms, that is 24 condoms per month.
oral contraceptive pills- combined and progesterone only pills- COCP, POP. In terms on medication, COCP is the most common among pills, depo-provera IM injectios and Multiload copper IUCD.
COCP used in Sik are Regivedon, Marvelon. Starts 42 days after delivery or when menstrual cycle starts. Not used if candidate have risk factors or history of heart disease, thromboembolism, breast and ovarian cancer.
POP used is Noriday- commonly used if mother is still breastfeeding. Starts by 0-6 months after delivery; COCP causes non-lactation..
Both COCP & POP are available in all KK and KD is Sik. Can be started by staff nurses, community nurses, MOs, FMS. Before starting them on pills, an extensive history is taken regarding the heart diseases, breast problems, thromboembolism.
Depo provera injections via IM lasts for 3 months, also available in all KK & KD in Sik. Can be administered by staff nurses, community nurses, MOs, FMS.
IUCD is only available in KK Jeniang (because FMS is stationed there) and KKIA Sik (by MO or FMS only). Can’t be administered by nurses.
The IUCD used here is Multiload copper IUCD, its market value is rm 250. Mirena is RM500, therefore it is not used. Suitable for women who tend to forget.
IUCD lasts for 3 years. It is inserted 42 days after delivery or 5 days after mensus begin. First, US scan is done to measure the cervix length, based on that measurement, the applicator length is adjusted too. Upon insertion, US scan is done again to determine if it is correctly placed. A review is done 6 weeks later using US scan. After that, annual review is done. It is only removed when 3 years period expired or when mother plan to get pregnant.
All methods are provided free by KK & KKIA & KD.
For women who is having heart disease, renal failure, SLE and others, which pregnancy worsens the disorders, they will require Norplant or Implanon, lasts for 5 years, to be done in LPPKN clinic in Sungai Petani and Baling. The couple bear the costs.
JM Suraya says family planning is very well accepted by the people of Sik and she says it is working well.
The financial allocation is provided by finance unit of PKD, the Sister buys the stocks from either the supplier, or via government tender. From KKIA Sik, she distribute them to the other KK and KD.
Unfortunately, there is no NGO operating in this field in Sik.
INFRASTRUCTURE IN SIK.
INFRASTRUCTURE IN SIK.
By Mark Paul.
Area: 1635 km-persegi (biggest district in Sik)
Population: 74400 people.
Density: 46 per km persegi
Main economy: rubber plantation.
Health facilities: 1 district hospital, 2 klinik kesihatan (KK), 1 klinik kesihatan ibu anak (KKIA), 19 klinik desa (KD), 1 health office complex, 2 dental clinics.
KK: in Jeniang (have 1 FMS, 2 MO, 4 MA AND nurses), and Sik (have 1 MO, and nurses; FMS visits Sik KKIA every Tuesday from Jeniang.)
KD: attended by nurses.
Within the health district office complex: there are:
- KKIA SIK
- Laboratory
- 2 meeting rooms
- Staff quarters
- Office blocks for all the units.
- Dental clinic.
By Mark Paul.
Area: 1635 km-persegi (biggest district in Sik)
Population: 74400 people.
Density: 46 per km persegi
Main economy: rubber plantation.
Health facilities: 1 district hospital, 2 klinik kesihatan (KK), 1 klinik kesihatan ibu anak (KKIA), 19 klinik desa (KD), 1 health office complex, 2 dental clinics.
KK: in Jeniang (have 1 FMS, 2 MO, 4 MA AND nurses), and Sik (have 1 MO, and nurses; FMS visits Sik KKIA every Tuesday from Jeniang.)
KD: attended by nurses.
Within the health district office complex: there are:
- KKIA SIK
- Laboratory
- 2 meeting rooms
- Staff quarters
- Office blocks for all the units.
- Dental clinic.
Monday, July 20, 2009
SAFE MOTHERHOOD INITIATIVE 2 - SIK
Color Strings System on antenatal booklet for high risk pregnancy. (only in klinik kesihatan SIK)
It is one of the innovation project done by the Maternal and Child health clinic in Sik, under the program of Safe Motherhood Initiative. Strings with different color are tie on the right upper corner of both the antenatal booklets (Antenatal record KIK/1(a)/96 and KIK/1(b)/96) , according to the problem the antenatal mother is having. However, only
Antenatal Record KIK/1(a)/96 is kept in the clinic while the KIK/1(b)/96 is another copy for the mother. There are five colors of strings represent different antenatal problems:
- red – hypertension in pregnancy
- black – history of birth before arrival
- yellow – anemia in pregnancy
- blue – heart diseases in pregnancy
- green – diabetes in pregnancy
If there are two or more strings of different color are tied on the antenatal booklet, that means the mother has more than one antenatal problem, for example black and red strings are tied on the booklet means the mother is having hypertension and she had history of birth before arrival (BBA).
All antenatal booklets will be kept in the shelf, those color strings tie on the booklet will be easily notice and so as the antenatal problems. The clinic staffs can find the case with different antenatal problem according the string’s color faster and easier. Management of the antenatal mother can focus more on the high risk cases with strings tied, especially those tied with more than one strings will be given priority first.
The color string system strengthens the original Color Coding System (stickers of different color on the front page of antenatal booklet) because the strings system makes the searching of booklets easier and faster on the shelf.
Benefits gain after this innovation:
- management of antenatal cases become more effective and faster.
- priority is given accurately for high risk mother
- antenatal case with problem can be search from the shelf easier and faster
- more attention is given for those with multiple problem (i.e multiple strings)
- antenatal mother will be more alert as they know what problem they are facing
- substandard maternal care is decreased
Reference:
- Inovasi Keibua Selamat 1998 “Sistem tali berwarna pada kad antenatal kes berisiko”, pejabat kesihatan Sik Kedah Darulaman.
SAFE MOTHERHOOD INITIATIVE- SIK
TITLE: REDUCE INCIDENCE OF UNSAFE DELIVERY
Definition of safe delivery is any delivery that is conducted by a trained person.
Unsafe delivery is defined as all delivery that are not conducted by formally trained personnel. Classification:
- Birth before arrival of any trained person such as nurse or doctor (mother delivers the baby alone).
- delivery by TBA
- delivery by untrained people or non-medical staff such as husband or mother-in-law.
The total number of unsafe deliveries in Sik in 1994,1995 and 1996 are 8.0%,5% and 11.8% respectively, which is consider very high.
Health indicator
- % of unsafe deliveries
Number of unsafe deliveries among home deliveries x 100
Total of home deliveries
- % of perineal tears (2nd and 3rd degree)
- % of puerperal sepsis
Number ofpueperal sepsis among unsafe deliveries x 100
Total of unsafe deliveries
- % of neonatal tetanus
Service indicator
- % of Antenatal mother given advice on safe delivery
Number of antenatal mother given advice on safe delivery x 100
Total antenatal mother
- % of antenatal mother at term who defaulted and were traced within 24 hours
Number of antenatal mother at term who defaulted and were traced within 24 hours x 100
Total antenatal mother at term
- % of clinic staff given training on service of safe delivery
Number of clinic staff given training on service of safe delivery x 100
Total number of clinic staffs
- % of staff who attended motivation courses
Number of staff who attended motivation courses x 100
Total number of staff
- % of TBA who attended dialog session on safe delivery at least once a year.
Number of TBA who attended dialog session on safe delivery at least once a year
Total number of TBA
- % of unsafe delivery among high risk mothers.
Number of unsafe deliveries among high risk mother x 100
Total number of deliveries among high risk mother
Difficulty indicator
- % of unsafe deliveries due to non-availability of district nurses.
Number of unsafe deliveries due to non-availability of district nurses x 100
Total number of unsafe deliveries
Solution description
| Issue of concern problem area | Interventions |
| 1. Non-compliance of the mother | 1. Health education about safe delivery - for mothers during every antenatal visit. - to mother at inaccessible area during home visit - give printed text about safe delivery for Iman to read during Friday prayers -Focal group discussion who had experience of unsafe deliveries and complications. - activate Panel Penasihat and community leaders to advice/ assist in social problem of the mothers -distribution of pamphlets to all mothers.
|
| 2. Inadequate knowledge of staff about complication of unsafe delivery. | 1. organize talks by visiting specialist 2. increase frequency and quality of supervision/visit by supervisory 3. training programmes. |
| 3. lack of motivation in hospital/ health clinics staff. | 1. organize motivation talks 2. Islamic value by public service learn motivation counseling skill from counselor. |
| 4. Unavailability of district nurses | 1. Advertise date of leaves 2.cooperation from TBA |
| 5. Ineffective supervision | 1. increase frequency of supervison. 2. Appoint Staff with problems 3. give more attention to staff’s concern. |
Implementations:
- Hospital labor rooms visit by groups of antenatal mother who had no experience of delivering in hospital.
- special marking and black string tie on the antenatal check up booklet for those who had experience of unsafe delivery.
- nurses who have no experience of conducting a labor is sent to hospital for courses on conducting a labor.
- those antenatal mother who have risk of unsafe delivery are invited to a focal group discussion on the importance of safe delivery in health clinic.
- special arrangement is made for unwed mothers, they can have their antenatal check up at the day other than the antenatal day and if required, can be sent to other clinic to avoid public attention on them.
- talks is given in villages which are located far from health clinic about the problems of unsafe delivery.
- make sure all the antenatal mothers who are high risk for unsafe delivery have the chance to visit the hospital labor room.
- increase number of Alternative birth centers especially in inaccessible villages for away from the hospital. Eg. Health clinics in Both Jeniang and Bulau have their ABCs operated at year 2001.
Beneficial experiences in Daerah Sik
| Birth | 1996 | 1997 | 1998 | 1999 | 2000 |
| Total birth in District | 1302 | 1232 | 1243 | 1275 | 1266 |
| Total Home Delivery (safe) | 427 | 289 | 196 | 165 | 115 |
| Total unsafe delivery | 45 | 48 | 33 | 19 | 16 |
| % unsafe delivery of home deliveries | 10.5 | 16.6 | 16.8 | 11.5 | 12.2 |
| % general unsafe delivery | 3.46 | 3.9 | 2.65 | 1.49 | 1.3 |
Result of antenatal visit to hospital Sik (year 2000)
| Clinic | Total antenatal mother visit to hospital | Total visiting sessions to hospital | Total antenatal mother visit to hospital with partners | Total number of hospital delivery | Total number of delivery conducted by community nurses | Total number of unsafe delivery |
| Maternal and Child Health Clinic Sik | 80 | 12 | 24 | 74 | 6 | - |
| Health Clinic Jeniang | 58 | 12 | 5 | 56 | 2 | - |
| Health clinic Gulau | 48 | 12 | 9 | 38 | 10 | - |
| Total | 186 | 36 | 38 | 168 | 18 | - |
REFERENCES
- Yearly report of Safe motherhood initiative, district team problem solving, 1997.
- Projek Kumpulan Meningkat Mutu Kerja KKM
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